You’ve (Not) Been Warned

ABSTRACT

Content warnings are an essential accessibility feature in games with distressing and traumatic content. With mixed research findings and even more mixed public opinion, there are very few resources available to support developers who want to have content warnings in their games. The following article provides a brief historical overview and current research on the use of content warnings, case examples games that have successfully utilized content warnings, and best practice guidelines for content warning language and implementation.

1 INTRODUCTION

Content warnings are an essential accessibility feature in games where distressing and traumatic content is presented. There is no industry standard for providing content warnings—not in games, not in game studios, and not at game events. There is not even agreement that content warnings are needed. However, content warnings around psychologically distressing topics are a safety and accessibility issue. Accessibility, in the sense that it is used here, refers to providing access to content that might otherwise be inaccessible due to psychological vulnerabilities. By developing best practices in creating content warnings, normalizing the use of content warnings in game spaces, and providing guidance on how best to deploy these warnings with both in-person and digital audiences in mind, the games community has the capacity to create spaces where exploring difficult emotional content is safe and inclusive.

1.1 Trigger and Content Warnings: History and Controversy

The practice of warning audiences about potentially hazardous content is nothing new. Films have been using the Motion Picture Association age rating system for over 50 years and the Entertainment Software Ratings Board, the digital game equivalent of film ratings, turns 30 years old in 2024. These warning systems are broad acknowledgment that not all content is for all people, but when dealing with psychologically distressing or traumatic content there is more in-depth work to do. Effectively utilizing content warnings around traumatic or distressing content enables people to make informed decisions about their own well-being. It is a way of granting self-determination, respect, and agency to those people in our care—our audiences, our students, and our players.

The term “trigger warning” first emerged via the internet in the 1990s in feminist news and blogging spaces [40]. These warnings were originally intended to alert readers that the following material contained traumatic content, specifically graphic depictions of sexual assault [14] and eating disorders [40], which may “trigger” traumatic memories or reactions similar to Post Traumatic Stress Disorder (PTSD) symptomology or associated emotional experiences [22]. Authors used these warnings to protect their readers, many of whom experienced similar significant trauma histories. Trigger warnings were an act of compassion born from communities of care.

The term quickly expanded, both in meaning and in reach across the internet. These warnings began to appear on other early user-driven social platforms like Livejournal, Tumblr, and Archive of Our Own [11]. The term began to encompass warnings beyond sexual or physical trauma, such as common phobias, suicide, and self-harm, and eventually branched out to include social trauma (e.g., depictions of racism, discrimination) [14]. This shift from providing warnings about specific emotional and physical trauma to broader social and psychological distress spurred a shift in how these warnings were described or labeled. For example, terms like “content notes” and “content warning” emerged in the early 2010s to acknowledge that “even if somebody isn’t triggered, there still might be something that they don’t want to read” [40].

In contemporary use, the terms content warning and trigger warning are frequently used interchangeably [9]. While their original meanings served related but distinct purposes, they both currently function to alert the consumer that upcoming content contains potentially distressing material and provide brief descriptions of said content [6] . Considering the significant overlap of the terms and given the problematic socio-political [41] and clinical connotations [9] associated with the term “trigger,” this article will use the more general term “content warning” going forward.

1.2 Research and Public Opinion

Research into the effectiveness and clinical utility of content warnings is decidedly mixed. Some studies have found that using content warnings increases distress and anxiety [4–6] and negatively impacts resilience [4, 34]. Other studies report that content warnings are a form of accommodation for individuals managing mental illness [8, 17, 37], reduce the risk of re-traumatization [7], and are a social justice issue [33]. Still other studies have found that content warnings neither harm nor hurt, and that their impact is clinically negligible [24, 32]. In other words, based on available research content warnings do not appear to have a predictable, consistent clinical impact. This focus on clinical impact is important, because it means the provision of content warnings is not strictly a medical concern, but rather an accessibility issue mitigated by a social contract of consent and autonomy.

Outside of academia, there is no shortage of opinions on content warnings. Critics claim content warnings are a threat to free speech [36], a form of censorship [12], and are harmful to youth due to “coddling” of feelings [25, 26]. Or, as in the New York Times piece “If You Need a Trigger Warning, You Need PTSD Treatment,” content warnings are said to be “countertherapeutic” as they enable
avoidance and avoidance maintains PTSD [26].

Alternatively, those who support content warnings often point out they are the opposite of censorship; content warnings facilitate engagement with challenging content by facilitating a sense of safety and empowering individuals to take charge of their own well-being [39]. Furthermore, free speech is at its best when the safety of marginalized and vulnerable voices is ensured and prioritized [35]. As for the concern that informing people about potentially traumatic content promotes avoidance and thus maintains PTSD, that is simply not how treatment of PTSD or any other traumatic condition is addressed. In fact, it is completely counter to how ethical treatment of trauma, such as exposure therapy, is done [3, 23, 28].

2 CONTENT WARNINGS IN GAMES

From extensive work in game spaces around ethical design, it is evident that the disposition toward using content warnings in games is also mixed. In terms of resistance, push-back tends to cluster around one of three areas of concern. First, there is the worry that content warnings will “spoil” the creative experience or “ruin the surprise” and result in a loss of emotional impact. Second, some worry (especially in the games-for-impact space) that content warnings let people “off the hook,” and allow them to disconnect or check-out of challenging content at the cost of their own growth. The third argument is that games are art and art is supposed to push boundaries, to evoke
intense emotions, and even to unsettle or disturb.

2.1 Confronting Content Warning Misunderstanding and Misinformation

The following addresses each of the previously stated concerns in order. First is the argument that content warnings are a form of spoiler and will ruin the “surprise” within the game or otherwise negatively effect the “full emotional impact” [31] of the player experience. This argument assumes content warnings inherently spoil the experience and ignores the different ways content warnings can be designed to protect vulnerable players without revealing content for non-vulnerable players (specific techniques are discussed later in this article). Furthermore, if warning the audience about traumatic content ruins the surprise, then trauma has no purpose other than shock value [21]. It indicates that the trauma is not integrated into the narrative in a way that is meaningful [10, 31].

Regarding the concern that content warnings allow people to disconnect from difficult content, it is critical to keep in mind that if a person seems to be “checking out” or otherwise avoiding situations that contain traumatic content, it is likely because they have direct lived experience with that content. Content warnings are not about avoiding difficult topics but rather equipping people with critical knowledge they will need to engage in difficult content over a longer term. Labeling the deep end of the pool does not make the pool less deep [18], but it does let people know whether they will be in over their heads and prompt them to plan accordingly.

Last, content warnings do not suppress artistic expression, nor do they censor or sterilize art. The goal of content warnings is to support people in viewing difficult content, not in the censorship of content. Censorship is the suppression of information or expression; content warnings do not suppress artistic expression any more than the nutrition facts on a label suppress the nutrition of the food within.

While feelings about content warnings remain mixed, what is clear is that they were invented out of a desire to care for and protect others, usually people from marginalized groups. It was an act of creative compassion. Unfortunately, this core tenet has mostly been lost in the last decade and a half as the “trigger warning wars” have centered on controversy and moral panic [30]. However, it is this core of compassion we need to return to if we, as an industry, want to continue to create, explore, and discuss the strength and fragility of the human mind and the challenges and depth of the human experience.

3 CONTENT WARNINGS: BEST PRACTICES

Independent of any significant guidance or advocacy, game developers have become more proactive in the use of content warnings, especially in the indie game space. The following section provides examples of how recent games have been addressing content warnings including identifying potentially distressing content, crafting appropriate content warnings, and implementing effective, trauma-informed content warning systems. The lens through which these examples are evaluated is based on (1) recommendations established in higher education; (2) integration of ethical standards from the American Psychological Association’s ethical code; and (3) and adoption of established best practices in usability and design.

3.1 Informed Consent Requires Information

If a game is going to address traumatic or emotionally intense content, then a content warning is imperative. It demonstrates up front that you know your content, have given thought to how others might experience it, and have taken proactive steps to safeguard your audience’s well-being. Furthermore, a basic tenet of ethical behavior is if, while in a position of authority, your actions may cause foreseeable harm you must takes steps to mitigate that harm [2]. Game developers have the awesome power of creating engaging, impactful experiences and evoking intense emotions in players. To willingly engage in scenarios where intense or traumatic content is present requires players to place their emotional and psychological well-being in the hands of developers. In other words, players are trusting game developers with their psychological safety. As developers and designers, we need this trust from our players, because games cannot happen without play and play cannot happen without a sense of safety [16]. In the case of traumatic content, safety means players’ well-being is prioritized, their dignity and autonomy respected, and that difficult content is treated with respect and care. When players trust the developers, they are more likely to remain persistent and stay engaged even if things are hard [16]. This is especially important when your game deals with difficult content. Players want to go on these difficult emotional journeys, and it is our responsibility as designers to see them through the experience safely.

One relatively simple way to bolster safety and reduce the risk of psychological harm is by obtaining informed consent. Informed consent is a process wherein a person is made aware of potential risks or benefits of participation and therefore can make an informed decision about whether they want to participate.

3.2 Provide Information about the Content

The first step in informed consent is to provide sufficient information so a person can make an educated decision. While marketing and other external sources of information are helpful (which will be discussed later), the most direct way to ensure that players know what they are getting into is through a content warning. However, a good content warning takes work.

One of the most common mistakes when providing content warnings is that they are too broad or vague. The goal of a content warning is to provide enough information so a person can make an informed decision about their own well-being. It is impossible to make an informed choice without information. Therefore, general canned warnings such as “the following contains material that may be harmful or distressing to some audiences” are insufficient. How can a person possibly tell that they may be at risk of experiencing distress or harm when this is all the information they are given? They cannot.

While “traumatic or emotionally intense content” may seem vague, this is due to the individual nature of trauma. Everyone processes and copes with trauma in their own way, even if the inciting event is the same (i.e., resilience in the face of a natural disaster). Anticipating every possible trauma-history a player may have is impossible, however there are a few major topics that should be disclosed. The following list of content warning topics comes from the University of Connecticut’s Office of the Provost (University of Connecticut, n.d.):

• Rape
• Suicide
• Incest (including any and all elements of romantic or sexual relationships between family, tonal in theme, thought, or activity)
• Sexual assault
• Excessive or gratuitous violence
• Kidnapping (forceful deprivation of/disregard for personal autonomy)
• Abuse (physical, sexual, emotional, verbal)
• Violence and trauma connected to racism and racial conflict
• Death or dying
• Child abuse or pedophilia
• Racial slurs
• Pregnancy or childbirth
• Animal cruelty or animal death
• Needles
• Miscarriages or abortion
• Self-injurious behavior (e.g., self-harm, eating disorders)
• Depiction of pornography (including child pornography)
• Blood

The University of Michigan also has a recommended content warning topic list that includes all the above and adds mental illness and ableism, sexism and misogyny, classism, transphobia, and homophobia [39]. To be clear, these lists were created for an academic setting and are neither definitive nor perfect guidance for game developers. Instead, the inclusion of these lists is intended to provide some concrete examples of the kind of topics developers should be thinking about and provide succinct, yet descriptive sample language developers can use in their games. For example, flagging for players that the game contains abuse is important, but specifying the type of abuse (e.g., child abuse, sexual abuse, etc.) provides players with clearer expectations and information from which they can make informed decisions. When dealing specifically with mental health-related content, a general best-practice is to be descriptive rather than diagnostic. Experience with mental illness is deeply personal and highly individualized and the sharing of a diagnostic label does not mean a shared experience. For example, there are 227 different ways to meet the diagnostic criteria for major depressive disorder [42]. Therefore, instead of using the diagnostic term “depression” in a content warning, it is generally preferable to use related descriptive terms such as “negative self-talk” or “feelings of worthlessness.”

3.3 Case Example: Hellblade: Senua’s Sacrifice versus Psychonauts 2

Hellblade [29] contains a content warning at the start of the game that calls out “representations of psychosis.” This warning is helpful as it identifies a specific area of potential sensitivity. However, the term “psychosis” is still somewhat broad and can convey different meanings. Psychosis is an umbrella term that encompasses several different types of mental illness, symptoms, and experiences and is a phenomenon that varies by culture [1]. So while “representations of psychosis” is better than a generic “viewer discretion is advised” warning, and infinitely better than no waring, there is room for improvement. A more descriptive content warning would replace the term “psychosis” with experiences represented in the game: “This game contains representations of voice-hearing, distorted perception of reality, confusion, out-of-body experiences, and intrusive thoughts.” And, since Hellblade contains scenes that are quite violent, the content warning should also include specific mentions of the kinds of violence depicted, such as body-horror, torture, and mass murder.

Psychonauts 2 [13] features a mental health advisory message at the start of the game that reads, “Psychonauts 2 contains artistic interpretations of serious mental conditions including addiction, PTSD, panic attacks, anxiety, and delusions. There are also images that may be upsetting to people with a fear of dentistry, tight spaces, or vomit. The conditions are usually presented in a lighthearted or even comical manner but still may be distressing to some players.” The Psychonauts 2 mental health advisory is a solid example of a well-written, highly informative yet compact content warning. While it does use broad terms like “addiction” and diagnostic terms like “PTSD,” these representations are equally broad in the game. Alternatively, the content warning does address three very specific vulnerabilities, fear of dentistry, tight spaces, and vomit. These three vulnerabilities are prominently featured in the game and require player engagement to navigate. They also happen to be things that many people have strong or even phobic aversions to. In short, the intensity and specificity of potentially distressing topics in-game is reflected by the directness and specificity in the content warning.

3.4 The How and When

When providing a content warning, when and how the warning is conveyed is important to consider. The case examples above both appear at the very start of the game without any effort from the player. This is another general best practice as players should not have to look through menus or game settings to find a content warning. One significant difference between the Hellblade and Psychonauts 2 content warnings brings up the ethical guideline around seeking player assent. In research and clinical spaces, obtaining informed consent from a participant is fundamental to ethical practice [2]. Assent simply means to agree to something after a period of consideration [27], and seeking assent from players ensures, as much as possible, that they have reviewed the content warning and agree to continue. Hellblade’s content warning both loads and fades away without any player input; that is, the game does not require player assent. Due to the pre-determined amount of time the content warning is on screen, it is possible to entirely miss the content warning and the information and resources within. Furthermore, while the length and depth of the Hellblade content warning is admirable, the quality of the content does not matter if the player is not given time to read it. In this case, seeking assent is not only ethical but also makes the information more accessible as some players may need more time to read, to consider if this game is a good fit for them, or to write down the resources provided in the content warning. Alternatively, Psychonauts 2 sidesteps all these issues and obtains player assent with a simple “continue” button on the bottom right hand of the mental health advisory screen. While this is not a guarantee a player has read the advisory, it does improve the likelihood that someone who is actively looking to be forewarned of distressing topics is able to get the information they need.

Up until now, the discussion of content warnings has focused on a single interaction with the player at the start of a game. In most cases, a well-written content warning can stand on its own and serve as a self-selecting filter for self identifying those who are comfortable with the content and those who would rather not engage. The indie game space has created some incredibly creative and clever ways to alert players to potentially distressing content and have crafted systems that allow for more flexibility, personalization, and safety. Three notable examples are Chicory: A Colorful Tale [19], Inkenfell [20], and I Was a Teenage Exo-Colonist [30].

Chicory: A Colorful Tale is a top-down adventure game that takes place inside a coloring book. Despite its cute art and childlike premise, the game touches on some heavy topics. Chicory does not have an upfront content warning and instead opts for a continuous content warning system. If the content warning system is enabled by the player via the game’s menu settings, then the game will present in-game pop-up warnings immediately preceding specific content and provide the player the opportunity to skip it. For example, one such pop-up warns, “Upcoming sequences contain scary imagery and cartoon vomit.” The pop-ups also allow for players to skip the sequence that contains the distressing content and provides a re-cap of what, if any, important information was contained in the skipped scene. In this way, Chicory empowers players to take charge of their own well-being on a more case-by-case basis without any potential coercion or concern of “missing out” on relevant gameplay information or experience.

Inkenfell also uses a continuous content warning system. Like Chicory, these warnings usually occur right before a cutscene and allow players to skip the cutscene. Inkenfell is exceptionally good at providing informative but brief warning language. In addition to the content warning itself, the pop-ups sometimes also contain text describing how the potential content shows up. For example, one pop-up warns, “mention (but no depiction of) blood, horror.” For a player with an aversion to seeing blood, this clarification would be incredibly helpful and they may be less likely to skip the content because it is clearly identified as containing a reference to blood but no visual.

While Inkenfell and Chicory are similar in their approach to content warning systems, I Was a Teenage Exo-Colonist (IWTEC) takes a completely different approach. First, while Inkenfell and Chicory’s content warning options (e.g., the option to turn content warnings on) are within settings menus, IWTEC has a button on the main menu called “content warnings” that, if clicked, takes players to a list of broad topics including major character death, animal cruelty, and body horror. The list is an accordion and clicking on a topic opens a drop-down that contains detailed information such as “One of your childhood friends can die suddenly” or “Characters are seen drinking alcohol and consuming mild hallucinogenics.” And while information is provided, the descriptions do not spoil the content. For example, “A woman’s hand is broken in a public display of power” warns of violence and misogyny but does not disclose who the character is or when this event occurs. In the menu, however, there is a specific tab labeled “(Spoilers) Exactly who dies?” that discloses the names of those who can potentially die in the game, the circumstances of their deaths, and if their deaths can be avoided. It should also be noted that the entire content advisory menu is available on the game’s website. Having this information available before a player downloads the game reflects the developer’s dedication to prioritizing player well  being and making the information as accessible as possible.

3.5 The Role of Marketing

As the above examples have demonstrated, there are many unique and clever ways to integrate content warnings into a game. An additional avenue to informed assent from players lies outside of the game and can be employed even before the game is released.

How a game is marketed can have a significant impact on the extent and depth of a game’s content warning. Marketing is all about setting player expectations by providing significant bits of information about the game’s themes, story, and gameplay to players in advance. The more straight-forward a game’s marketing materials are about potentially distressing content, the less work a content warning is required to do. For example, a hypothetical game called “Arachnophobia” with a giant tarantula on all the art assets is clearly not an appropriate game for someone with a fear of spiders. Similarly, there are genre expectations that can also inform player choices, such as blood and gore being common in certain types of horror games. Things become a bit trickier when the marketing or promotion is more deceptive. 1While not specifically a content warning, Grounded (Obsidian Entertainment) and Webbed (Sbug Games) are games prominently featuring spiders and both provide “arachnophobia modes.” In both games, this mode changes spiders into spherical blobs, a built-in psychological accessibility accommodation.

3.6 Case Example: Doki Doki Literature Club

Doki Doki Literature Club (DDLC) is a prime example of a game whose (original) marketing was intentionally misleading and misaligned with actual game content. A game like DDLC, one with cute anime art style and a visual novel aesthetic, is seeking to subvert expectations to enhance the psychological horror of the game. While this makes sense from a gameplay perspective, it is at odds with prioritizing player well being. The point of this example is not to say that DDLC is bad or unethical but that the use of deception when traumatic content is present requires additional precautions.

In research settings, the use of deception is ethical if additional steps are taken to ensure safety during and after the experiment. The same principle applies to games like DDLC; games can be secretive and subversive but will need to integrate additional supports for players. For example, offering the option to view content warnings is enough of a flag for vulnerable individuals to take note and do some research before playing without spoiling anything for non-vulnerable players. The content warning specifics do not even need to be in the game (though that is preferable) but direct players to a website for a full list of disclosures and links to content warning-specific resources (i.e., if the game depicts domestic violence, then provide links to domestic violence prevention/support websites or hotlines). These resources are helpful regardless; however they are especially needed in games where traumatic content is intentionally obfuscated.

4 SUMMARY

Content warnings are an essential component to creating a more accessible and equitable gaming space for both players and developers. Content warnings can range from simple messages to elaborate systems, but their goal is always the same—to provide players with the information needed to make an informed decision about their engagement with the content. Content warnings demonstrate an acknowledgment of and respect for psychological vulnerabilities and facilitate access to content, information, and opportunities that might otherwise be inaccessible to people with those vulnerabilities. Despite frequently portraying significant trauma (e.g., death of a child, sexual assault, abuse, transphobia, etc.), the use of content warnings in games is the exception rather than the rule.

Significant strides have been made, particularly in the indie game space, around normalizing the use of content warnings and implementing innovative ways of conveying important psychological safety information to vulnerable players. By utilizing case examples of games with effective and innovative content warnings and integrating best practices from trauma-informed pedagogy and the psychological code of ethics, this article sought to create guidelines around the use of content warnings in games. These guidelines centered around the concept of informed consent and how content warnings are a way to engage players in an informed consent process. Best practices in how to structure content warnings, guidelines for appropriate language and terminology, and recommendations on implementation strategies were discussed. Overall, the approach prioritizes player well-being by enabling players to make informed choices about their own health and wellness.

A secondary goal of this article was to contextualize the current discourse around content warnings to de-politicize their use and correct common misconceptions or misunderstandings around their purpose and utility. When working in this space, the pushback against the use of content warnings can be particularly strong and sentiments such as “you can’t tell me what to do” or “you’re censoring my art” are not uncommon. Content warnings provide transparency and information that increase access and engagement and in no way suppress, block, or otherwise cancel the content they are attached to. Content warnings are about minimizing harm, valuing autonomy, acknowledging diverse lived experiences, and actively choosing to do right by our players.

In addition to player safety and accessibility, content warnings are an empathy issue. Empathy is an entirely internal experience—it is the ability to imagine and understand the experience of someone else without needing to have had the same experience [15]. Empathy put into action, that is, when someone experiences empathy and does something about it, is called compassion. We use content warnings when we talk about emotionally distressing content, because we choose to act compassionately. We can imagine someone in the audience being reminded of the worst day of their life and doing what we can to minimize that pain. We use content warnings because we respect players as full human beings with the right to know if they are potentially in harm’s way and be provided the opportunity, dignity, and respect to determine if the content is appropriate for where they are in their healing or aligned with their psychological well being and coping resources at that moment in time. We use content warnings at industry and professional events, because survivors and those with mental health challenges deserve the opportunity to learn and develop without sacrificing their safety.

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